The Department of Human Resources
H
I R I N G
R
E P O R T
Hiring Department
Type of Hire:
New Hire
Rehire
Internal Transfer
Agency Transfer
Position Title/Faculty Rank:
Dept./Educ. Discipline:
Salary/Wage to be Offered: $
Budget Code:
Promotion
Position No.:
Projected Start Date:
Appointment End Date:
(req. for wage positions)
Moving/Relocation Reimbursement: $
Building & Office Location and Phone.(ex: Lancaster 212A, X2074):______________________________________REQUIRED
NO RECRUITMENT
Was this candidate the only applicant considered for this position?
Yes
No
If no, complete and submit page 2, along with interview documentation/notes from all panel members.
Candidate Information:
Title:
Dr.
Mr.
Miss
Mrs.
Ms.
Name (First Name, Last Name)
Mailing Address (Street/PO Box)
City/State/Zip
Date of Birth
Phone Number
Benefits:
Full Benefits
Tenure Status:
Tenured
Tenure Track: Year of Review:
Additional Terms or Special Considerations:
For Instructional Faculty Positions Only
No benefits
Partial
Non-Tenure Track: 1 yr. appt.
Hiring Manager/Dept. Head Approval: ______________________________________ Date______________
Dean’s Approval (faculty only): ______________________________________ Date______________
VP Approval: ______________________________________ Date______________
Human Resources
Job Offer made by:
Date:
Is Candidate eligible to work in US:
Offer Accepted
Yes, as offered
Yes
No - VISA and/or Immigration Consultation
Yes, with noted changes
No
Notified Hiring Dept.
Yes, on
Comments
Clery Act Notices sent:
Yes
No
Background Check/Fingerprints
Yes, on
Does hire requires HR Director Approval
No
Yes
Date:
Copy of Hiring Report to Budget:
HR Dir. Approval:
Verify Budget Code with RR:
Recruiter Approval:
Date:
HRIS Manager: Banner Record:
ROLE CODE: ______________
PMIS Record:
SOC CODE: ______________
SUPERVISOR: _______________________
Employee ID No.:
WC CODE: ______________
WORK MODE: ____________ EEO _______________
Revised 10/12/12
HIRING REPORT PAGE 2
POSITION NO.:
Hiring Department
List All Applicants
Interviewed
Internal/
External
Gender
*Race
*A=White B=Black =Hispanic =Asian
E=American Indian U=Unknown
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Reason Selected or Not
Selected
Important Note: Any candidates interviewed by telephone, as well as those offered an interview, must
also be listed above.
Interview Panel Members
Date interviews conducted
Name
Title
Date
Name
Title
Date
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Title
Date
Name
Title
Date
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Title
Date
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Title
Date
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Title
Date
Name
Title
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Title
Date
Revised 10/12/12